单双侧穿刺经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究

Contrastive analysis of the unipedicular and bipedicular kyphoplasty in treatment of osteoporotic vertebral compression fracture

目的比较单、双侧椎弓根穿刺经皮球囊扩张椎体成形术(PKP)治疗骨质疏松性椎体压缩骨折的临床效果及安全性。方法回顾性收集2014年1月至2015年6月山西医学科学院山西大医院收治的PKP患者82例,其中男性35例(42.68%),女性47例(57.32%),平均年龄(68±7)岁,单侧穿刺组51例,双侧穿刺组31例。随访并比较两组患者手术时间、骨水泥注入量及X线透视次数,比较术前、术后2 d、6个月及1年时伤椎前缘高度、伤椎中部高度、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)变化。结果 82例患者均获得完整随访,随访时间(13.2±1.2)个月,单侧组的手术时间、X线透视次数、骨水泥注入量明显低于双侧组,差异有统计学意义(t=9.782,t=23.097,t=5.049,P<0.05);两组患者VAS、ODI评分较术前均明显降低,差异有统计学意义(F=779.477,F=465.976,P<0.01),组间比较差异无统计学意义(F=0.310,F=0.699,P>0.05)。两组术后伤椎前缘及中部高度较术前均明显增加,差异有统计学意义(F=74.955,F=27.330,P<0.01);组间比较差异无统计学意义(F=0.091,F=0.007,P>0.05)。结论单、双侧入路PKP治疗骨质疏松性压缩骨折在疼痛缓解方面均取得满意疗效,但单侧治疗具有手术时间短、术中透视次数少且操作简单等优点。

Objective To compare the radiological and clinical results of unilateral and bilateral percutaneous kyphoplasty for treating osteoporotic vertebral compressive fractures.Methods A retrospectivestudy was performed in82cases of osteoporotic vertebral compression fractures who undergone PKP from January2014to June2015in our hospital.There were35males(42.68%)and47females(57.32%),the average age was68±7years,all patients were classified into two groups,unilateral group(51cases)was treated with a unilateral approach and bilateral group(31cases)with a bilateral approach.The mean operative time,the mean X-ray exposure frequency and amount of bone cement were recorded.Preoperative and postoperative average vertebral body height,visual analog scale and Oswestry disability index scores were compared within each group and between two groups.Results All the82patients received an average of13.2±1.2months of follow-up.The mean operative time,the exposure time to X-rays and the amount of bone cement was shorter in the unilateral groups than that in bilateral groups(t=9.782,t=23.097,t=5.049,P<0.05).The postoperative VAS score and ODI in two groups were decreased than the preoperative data,difference was statistically significant(F=779.477,F=465.976,P<0.01),but the inter-group comparison was not significantly different(F=0.310,F=0.699,P>0.05).The anterior and middle vertebral height restoration was well increased in two groups(F=74.955,F=27.330,P<0.01),but the inter-group comparison was not significantly different(F=0.091,F=0.007,P>0.05).Conclusion There was no difference in pain relief and the average vertebral body height when treated with either unipedicular or bipedicular kyphoplasty,but the unipedicular kyphoplasty has the advantage of less operation time,frequency of X-ray exposure,amount of bone cement and simpler procedure.